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瞬时弹性成像技术诊断非酒精性脂肪性肝病的性能评估
Performance of transient elastography in diagnosis of nonalcoholic fatty liver disease
文章发布日期:2017年11月07日  来源:  作者:庄小芳,孙 洁,王晓波,等  点击次数:806次  下载次数:258次

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【摘要】:目的探讨瞬时弹性成像技术在非酒精性脂肪性肝病(NAFLD)患者诊断中的应用价值。方法纳入2016年6月-2016年12月新疆维吾尔自治区中医医院无脂肪肝患者29例,NALFD患者92例,采集患者的一般资料,计算BMI,进行血常规、肝功能、血脂、血清胰岛素、AFP检测,并行肝脏CT、FibroTouch检测;以肝/脾CT比值为诊断标准绘制受试者工作特征曲线(ROC曲线),应用ROC曲线判断受控衰减参数(CAP)诊断NAFLD的能力,计算ROC曲线下面积(AUC),其诊断有效性检测采用Z检验,并利用约登指数确定最佳截断值。符合正态分布的计量资料2组间比较采用t检验,多组间比较采用单因素方差分析,进一步两两比较采用LSD-t检验;非正态分布的计量资料2组间比较采用Mann-Whitney U检验,多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验。结果无脂肪肝组以及不同程度NAFLD组患者的年龄、ALT、AST、血清胰岛素、脂肪衰减、肝脏硬度比较,差异均有统计学(P值均<0.05)。重度NAFLD组年龄明显低于无脂肪肝组(P<0.001)。CAP在无脂肪肝组与不同程度NAFLD组间比较,差异均有统计学意义(P值均<0.001),但中度及重度NAFLD组之间CAP比较,差异无统计学意义(P=0.127)。无脂肪肝组分别与中度、重度NAFLD组的肝脏硬度值比较,差异均有统计学意义(P值分别为0.034、<0.001),但中度与重度脂肪肝组间比较,差异无统计学意义(P=0.327)。无脂肪肝组分别与各程度NAFLD组比较ALT和AST水平差异均有统计学意义(P值均<0.001),且重度NAFLD组的ALT、AST水平均高于轻度NAFLD组(P值均=0.001)。无脂肪肝组分别与各程度NAFLD组比较,胰岛素水平差异均有统计学意义(P值均<0.05),但不同程度NAFLD组之间胰岛素水平差异无统计学意义(P值均>0.05)。CAP诊断轻度、中度、重度NALFD的最佳cut-off值分别是244 dB/m、272 dB/m、272 dB/m,AUC及其95%可信区间分别为0.778(0.663~0.894)、0.893(0.809~0.976)、0.942(0.886~0.998),P值均<0.001。结论瞬时弹性成像技术可作为无创性诊断NAFLD的可靠手段,CAP可定量准确评估NALFD程度,对NALFD的分级诊断有较好的应用价值,能有效地区分轻度和中度以上NALFD;但难以区分中度和重度NALFD。
【Abstract】:ObjectiveTo investigate the value of transient elastography (TE) in the diagnosis of nonalcoholic fatty liver disease (NAFLD). MethodsA total of 21 patients without fatty liver disease and 92 patients with NAFLD, who visited Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region from June to December, 2016, were enrolled. Their general information was collected and body mass index (BMI) was calculated. Routine blood test, liver function evaluation, and measurement of blood lipid, serum insulin, and alpha-fetoprotein were performed, and liver CT and FibroTouch were performed. The receiver operating characteristic (ROC) curve was plotted with liver/spleen CT ratio as diagnostic criteria, and the ROC curve was used to evaluate the ability of controlled attenuation parameter (CAP) to diagnose NAFLD. The area under the ROC curve (AUC) was calculated, the Z test was used to evaluate diagnostic effectiveness, and Youden index was used to determine the optimal cut-off value. The t-test was used for comparison of normally distributed continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the least significant difference t-test was used for further comparison between any two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between multiple groups. The chi-square test was used for comparison of categorical data between groups. ResultsThere were significant differences in age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum insulin, fat attenuation, and liver stiffness measurement (LSM) between the patients without fatty liver disease and those with varying degrees of NAFLD (all P<0.05). The severe NAFLD group had a significantly lower mean age than the non-fatty liver disease group (P<0.001). There was a significant difference in CAP between the non-fatty liver disease group and the groups with varying degrees of NAFLD (all P<0.001), while there was no significant difference in CAP between the moderate and severe NAFLD groups (P=0.127). There was a significant difference in LSM between the non-fatty liver disease group and the moderate NAFLD group (P=0.034), as well as between the non-fatty liver disease group and the severe NAFLD group (P<0.001), while there was no significant difference between the moderate and severe NAFLD groups (P=0.327). There were significant differences in the levels of ALT and AST between the non-fatty liver disease group and the groups with varying degrees of NAFLD (all P<0.001), and the severe NAFLD group had significantly higher levels of ALT and AST than the mild NAFLD group (both P=0.001). There was a significant difference in the level of insulin between the non-fatty liver disease group and the groups with varying degrees of NAFLD, while there was no significant difference between the groups with varying degrees of NAFLD (all P>0.05). The optimal cut-off values of CAP for the diagnosis of mild, moderate, and severe NAFLD were 244 dB/m, 272 dB/m, and 272 dB/m, respectively, with AUC of 0.778 (95% confidence interval [CI]: 0.663-0.894), 0.893 (95%CI: 0.809-0.976), and 0.942 (95%CI: 0.886-0.998) (all P<0.001). ConclusionTE is a reliable noninvasiveness method for the diagnosis of NAFLD. CAP can accurately and quantitatively evaluate the degree of NAFLD and effectively differentiate mild NAFLD from moderate or severe NAFLD and thus has a good value in the grading of NAFLD. But it is difficult to differentiate moderate NAFLD from severe NAFLD.
【关键字】:非酒精性脂肪性肝病;弹性成像技术;诊断
【Key words】:nonalcoholic fatty liver disease;elasticity imaging techniques;diagnosis
【引证本文】:ZHUANG XF, SUN J, WANG XB, et al. Performance of transient elastography in diagnosis of nonalcoholic fatty liver disease[J]. J Clin Hepatol, 2017, 33(12): 2366-2371. (in Chinese)
庄小芳,孙洁,王晓波, 等. 瞬时弹性成像技术诊断非酒精性脂肪性肝病的性能评估[J]. 临床肝胆病杂志, 2017, 33(12): 2366-2371.

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